MEDICARE: SLENTZ SURGICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1659666808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLENTZ SURGICAL LLC

Provider Business Mailing Address
First Line	:	319 W CALL ST
Second Line	:	BLDG B STE A
City	:	STARKE
State	:	FL
Zip	:	32091-3113
Country	:	US
Telephone Number	:	908-368-8100
Fax Number	:	908-368-8120

Provider Business Practice Location Address
First Line	:	319 W CALL ST
Second Line	:	BLDG B STE A
City	:	STARKE
State	:	FL
Zip	:	32091-3113
Country	:	US
Telephone Number	:	908-368-8100
Fax Number	:	908-368-8120

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEVIN D SLENTZ
Credential	:	MD
Telephone Number	:	908-368-8100

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	06/16/2011

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Directions to “SLENTZ SURGICAL LLC ” Practice Location

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